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Medial Malleolus – Inner Ankle: Anatomy

The medial malleolus is the bony prominence on the inner side of the ankle, formed by the lower end of the tibia. It stabilizes the ankle joint and is a common site of fractures.

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Things worth knowing about "Medial Malleolus"

The medial malleolus is the bony prominence on the inner side of the ankle, formed by the lower end of the tibia. It stabilizes the ankle joint and is a common site of fractures.

What Is the Medial Malleolus?

The medial malleolus is a bony projection located at the lower end of the tibia (shinbone) on the inner side of the ankle. It forms the medial boundary of the ankle mortise – the socket structure of the upper ankle joint (talocrural joint) – together with the lateral malleolus (outer ankle) and the posterior tibial margin. This mortise firmly encloses the talus (ankle bone) and guides movement of the ankle.

Anatomy and Function

The medial malleolus plays a key role in ankle stability and movement:

Joint stability: It limits inward lateral movement of the foot and helps prevent excessive pronation (inward rolling of the foot).
Ligament attachment: The deltoid ligament (ligamentum deltoideum) – a broad, fan-shaped ligament complex – attaches to the medial malleolus and provides strong medial support to the ankle joint.
Tendon pathway: Several important structures pass behind the medial malleolus, including the tendon of the tibialis posterior muscle, the flexor tendons, the tibial nerve, and the posterior tibial artery.

Common Injuries

Medial Malleolus Fracture

A fracture of the medial malleolus is one of the most common ankle injuries. It typically results from twisting or rolling of the ankle (supination or pronation trauma) and frequently occurs alongside injuries to the lateral malleolus or the ankle mortise. Fractures are classified using the Weber classification (Types A, B, and C) or the Lauge-Hansen classification.

Typical symptoms of a medial malleolus fracture include:

Severe pain at the inner ankle
Swelling and bruising (hematoma)
Tenderness directly over the medial malleolus
Reduced range of motion in the ankle
Visible deformity in severe cases

Deltoid Ligament Injury

The deltoid ligament can be partially or completely torn under strong pronation stress. Because this ligament is very robust, isolated tears are uncommon and usually occur in combination with bony injuries.

Diagnosis

Injuries to the medial malleolus are diagnosed using the following methods:

Clinical examination: Inspection, palpation, and stability testing of the ankle joint.
X-ray imaging: Standard two-plane radiographs to identify fractures and assess joint space changes.
Computed tomography (CT): Used in complex fractures for detailed bone visualization.
Magnetic resonance imaging (MRI): Useful for evaluating ligament and soft tissue injuries.

Treatment

Conservative Treatment

Stable, non-displaced or minimally displaced fractures and ligament injuries are often managed conservatively with:

Immobilization in a lower leg cast or ankle brace
Non-weight-bearing with crutches
Swelling management (ice, elevation, compression bandaging)
Physiotherapy to restore strength and stability

Surgical Treatment

Displaced fractures, unstable joint conditions, or complex injuries typically require surgical intervention. The fracture is stabilized using screws, plates, or wires (osteosynthesis) to restore normal anatomical alignment and promote proper healing.

Rehabilitation

Targeted rehabilitation following treatment is essential for restoring full ankle function. It includes physiotherapy exercises to strengthen surrounding muscles, balance training (proprioceptive exercises), and gradual weight-bearing progression. The duration of rehabilitation varies based on injury severity and treatment approach and may range from several weeks to months.

References

Rüter, A., Trentz, O., Wagner, M. (Eds.): Unfallchirurgie. Urban & Fischer Verlag, Munich, 2nd edition, 2004.
Lauge-Hansen, N.: Fractures of the ankle. Archives of Surgery, 1950; 60(5): 957–985.
Court-Brown, C. M., Caesar, B.: Epidemiology of adult fractures: A review. Injury, 2006; 37(8): 691–697.

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